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It started with just an insect bite. Of course, for Max, it was never "just" anything. It was always a precursor to something much bigger, something that would surely be the death of him! So when he ran in and shoved his foot into my face, my first reaction after disgust was to roll my eyes.

"What the hell, Max?"

"Look!" He pointed dramatically at a small, red bump that had formed on the side of his ankle.

"An ant bite?"

My twin shook his head with a distraught frown, "I think it's a spider!"

I regarded him flatly, beyond unimpressed, and shoved his foot away so I could see the TV again, "So?"

"Do you know what spider bites can do to you?"

"Give you superpowers?"

He didn't appreciate my glib response, "I'm serious! What if it was a black widow or a brown recluse or a-a-a..."

"A fire ant."

He clenched his hands into fists and snorted with frustration. I wanted to take him seriously, I'd been wanting to take him seriously for nineteen years, but I just couldn't. Somewhere down the little boy assembly line of snips, snails, and puppy dog tails, someone had added a whole bag of crazy to the mix and Max had hoovered it all up. A compulsive liar with ADHD, anxiety, and hypochondria, he was an exhausting person to be around. As his identical twin, people always assumed that I had some mystical bond with him, a deep understanding that would allow me to forever forgive his transgressions. People are idiots.

I loved him as best I could and I knew that he never meant to be so...Max, but that didn't mean I was immune from getting fed up with it all. As kids, I'd been extremely jealous of him and spent a long time assuming that all the extra attention he got from our parents was because they loved him more. I'd resented them so much growing up and had spent most of high school going through a rebellious phase of bad haircuts and binge drinking. It wasn't until we started college and Max and I lived together, just the two of us, that I began to truly understand. All of the time our parents had spent with him, all of the energy and attention, hadn't been because they favored him, it was because he required it. He still required it, but since our parents were hours away and he and I shared an apartment, I'd become his new go-to for all things big and small.

The spider bite was just the latest complaint in a long line of issues. Yesterday, a bad sushi roll was the end of the world, last week his professor coughing on him had him in fit, a month ago, a girl standing too close while she spoke to him made him hyperventilate, and I'd had to be the one to piece him back together each time. I'd tried looking into school services to get him some help a couple of times, but Max steadfastly refused. He'd seen a number of shrinks and taken pills by the fistful over the years, but he said it never helped. I doubted he'd ever stuck to any one treatment long enough for it to be effective, but I didn't tell him that.

"Spider bites are serious, Ben." He said gravely, "I could get necrosis, paralysis, I could die!"

"Or you'll get a little itchy for a couple days." I dismissed him as I always did and grabbed my phone from the coffee table, "What kind of pizza do you want? My treat."

I had just about managed to fall asleep, full of pizza and floaty from a few beers, when the screaming started. I kicked off my sheets, more annoyed than concerned, tugged on a pair of pants, and marched across the hall to Max's room. He was dancing around wildly beside his bed, shrieking and slapping at his bare skin. He bowled into his desk, knocking his lamp to the floor, and then slammed into the wall, where I pinned him until he calmed enough to speak.

"There was a spider," he said breathlessly, pointing to his bed.

"Seriously, dude?" I flipped his pillows and shook his comforter out. When nothing tumbled off, I balled it up and threw it at him, "Shut up, I'm trying to sleep."

I left him standing in the middle of his room, naked and hugging his comforter, and went back to bed. He didn't scream any more that night, but I could hear him moving around restlessly between his room and the living room. I sighed, at once sorry for and irritated by my brother, and rolled over to fall back asleep.

"What's your problem?" I asked over breakfast the next morning. Max had been fidgety since he woke up, if he even slept at all, and was raking his nails absently across his skin.

"Nothing," he said and kept on scratching.

I shrugged it off, figuring it was just another instance of Max being Max, and tried up ignore him.

"I got bit again," he said in a sudden rush, "Another spider, I'm pretty sure. I could feel it crawling on me last night, even after you went back to bed."

"Uh huh."

"I think it's still in my bed."

"Okay."

"I'm serious, Ben!"

"Yep."

He shoved himself away from the table and tore his shirt off to point to a spot on his shoulder, "Look!"

"Zit."

"It's a bite!" He was almost whining.

"Sure, whatever."

When he saw that I wasn't going to be convinced, he stormed out of the kitchen and locked himself in his room. Probably googling spider bite reactions so he can show me later, I thought mockingly, and got myself ready for class.

Max usually held on to an injury or illness for only as long as it got him attention. I expected the spider thing to go on for another day or two, until he realized I wasn't going to play along, but he was stubborn this time. Every day he'd show me a new mark, a new bump, even a mole, and insist it was a spider bite. He was tireless in his efforts to patrol the apartment, looking for signs of his arachnid assailants. His school work fell to the wayside as he became consumed by researching every type of spider in our area, their toxins, ways to trap them, ways to kill them. I tried to dissuade him, but it was all distracted, halfhearted attempts that usually ended with me calling him some variation of dumb. I had my own life to worry about and if he were going to fail sophomore year of college because he wanted to believe in invisible spiders, what could I do?

We lived like this for a couple of weeks, him obsessing and me trying to block it out, before I really started to get concerned. Max had believed some outlandish things before, but never to this extent and never for so long. He was constantly nervous, hardly eating, and I was starting to wonder if he was getting any real sleep. Dark circles deepened around his eyes, giving him a haunted look, and he paced endlessly from room to room, hugging his thinning frame and scratching. Always scratching.

"I can feel them." He whispered one night while I tried to bribe him to eat with food from his favorite barbecue place. His fingernails trailed along his already inflamed, irritated arm. Unconsciously, I rubbed my own to ward off sympathetic soreness, "They crawl all over me. I try to sleep, Ben, but they crawl and they bite. See?"

He rolled up his pants, took off his shirt, displayed himself with arms outstretched. I saw for the first time the full extent of his self injury; all of the hair on his arms and legs had been scratched off, leaving jagged, angry welts across his bare flesh. Trails of dried blood marked where he'd dug too deeply. His body was riddled with gouges, slashes, and dark bruises from where he'd been slapping himself. He stared at me, his eyes glittering feverishly with desperation and a hint of triumph.

"Jesus Christ!" I breathed. Guilt, hard and heavy, slammed me in the stomach. How had I not realized what he was doing to himself? Because I was being selfish and petty, ignoring his cries for help because I couldn't be bothered. I made him put his shirt back on and sat him down in the couch beside me.

"You believe me now?" he asked, scared and hopeful.

I nodded. I believed that he believed and it was hurting him.

"We should go to a doctor. For the bites," I said.

He looked at me strangely, "A doctor can't help me."

"Sure they can. Come on, get dressed, let's go." I just needed to get him in the car and over to the emergency room. They would be able to do a psych hold, my parents could come, they'd take care of him. Why hadn't I called them sooner? I wanted to punch myself repeatedly for watching my brother's downward spiral and not doing anything to help. Our parents were going to be pissed.

Max was scraping his nails harder and faster with agitation. Blood, fresh and bright, beaded along his arm, smearing and spreading with each additional pass.

As gently as I could, I took Max's hands and held them between mine, "Come on, man, we need to get a doctor to look at these bites. I'm sorry I didn't believe you before, I just didn't see them."

Max nodded slowly, his fingers twitching in my grasp, "But you see them now?"

"Yeah."

He pulled away from me and paced twice around the living room, "Good...good...I knew it was real." He seemed to relax, the weight of his delusion lifted slightly. He turned from me and walked into the bathroom.

While he was getting ready to go, I called our parents and did my best to explain what was happening. They were upset, but more with the situation than with my negligence. They didn't blame me for my inexperience or ignorance, having shielded me from his conditions as best they could for our whole lives, and just asked where I was taking him so they could meet us there. Once we'd worked out the specifics, I hung up, relieved.

"Max," I called while grabbing my keys, "let's go!"

He didn't respond.

"Max?"

The bathroom door was left ajar and I could hear the sink faucet running. Max, although muffled by the running water and barely audible, was whimpering. I knocked softly, trying to figure out how I could soothe him enough to get him in the car, and pushed the door open.

Max had stained the tiles around his feet. One hand was slowly working the razor, which he'd pried out of a disposable head, up his leg, sawing through skin, muscle, sinew. With his other hand, he was peeling the flap of flesh back, tugging it away with wet pops and snaps. In the mess of dripping, torn red, a flash of white where he'd gone down to the bone. Chunks from his arms, his stomach, his thighs clogged the drain and littered the bathroom floor. Raw meat that had been my brother. Bile churned in the back of my throat when he turned to face me. One cheek had been stripped down almost to the teeth and it was clear he'd at least started on the other. The skin flapped loosely beneath his eye and rivulets of tears and blood ran from it.

I fought back a wave of nausea and managed to utter his name, "Max..."

"They got under my skin, Ben; I can feel them." I didn't know that a person could speak with such agony twisting their voice, "I'm getting them out. You still believe me, right?"

The hospital kept Max for a long time. His wounds were extensive and the treatment he'd need would be ongoing and intense. Mom and Dad got me a hotel room, offered to have one of them stay with me, but ultimately both went to stay with Max. Just like it had always been, just like it always had to be. Every time I closed my eyes, I'd see his face, once identical to min|e, shredded and mournful and carved with torturous pain. I lay in the uncomfortably soft bed, tossing and turning, trying to banish Max from my mind. But I had done it to him, hadn't I? If I hadn't said I believed him, if I'd told him he needed help, he wouldn't have gone so far. I shouldn't have fed into his fantasy. Any way I tried to spin it, I ended up with the same conclusion: it was my fault. I was back and forth between the bed and toilet, vomiting up guilt and regret. The night wore on and my brother and his spiders crawled through my mind, filling it, flooding it. It wasn't until sheer exhaustion forced them into a black silence that I was able to close my eyes and roll over, more than ready for sleep to distance me from the night's events.

With only a thin thread tying me to consciousness, I was barely aware of the tickle of eight small legs skittering across the back of my neck.